Systemic Methylprednisolone Research Articles

Granulomatosis with polyangiitis masquerading as disseminated tuberculosis in presence of bilateral lung cavities and hemorrhagic infarct

Lung cavitations with constitutional symptoms are usually associated with pulmonary tuberculosis due to its high prevalence and are the most common infectious cause in India. Granulomatosis with polyangiitis (GPA) with the systemic pulmonary disease will have different radiological presentations such as nodule, mass, and consolidation with or without cavitation. In this case report, we have reported a 40-year-old female presented with cough, fever, and weight loss of 6 months duration with chest imaging suggestive of bilateral cavitary lung disease. She was labeled as a case of disseminated tuberculosis due to involvement of the central nervous system and empirically treated with anti-tuberculosis treatment (ATT) without microbiological evidence of tuberculosis in smear and cartridge-based nucleic acid amplification tests. The absence of clinical response and radiological worsening to empirical ATT gives a clue for an alternate diagnosis. Bronchoscopy workup documented Aspergillus colonization and vasculitis workup in the presence of cavitary lung disease documented abnormally raised proteinase 3 anti-neutrophil cytoplasmic antibodies titers. She was treated with a combination of systemic methylprednisolone and azathioprine with voriconazole. Her clinical response was observed in 4 weeks and radiological response with complete radiological clearance of pulmonary cavitations was documented after 6 months of treatment. We recommend prompt workup and ruling out GPA in all cases with pulmonary cavitations with negative microbiological workup and no empirical ATT should be given in the era of rapid microbiological tests with good sensitivity and specificity.

Efficacy of high dose systemic versus combined (systemic and intratympanic) corticosteroid therapy in idiopathic sudden sensorineural hearing loss: A prospective randomized trial and risk factor analysis

The pathophysiology and the proper treatment of idiopathic sudden sensorineural hearing loss (ISSNHL) are an ongoing subject of debate. Locally or systemic administered corticosteroids are the most accepted drugs of treatment in reference to ISSNHL (idiopathic sudden sensorineural hearing loss), however, no strong evidence nor guidelines regarding their effectiveness yet exists.In our prospective, randomized, controlled trial 78 participants were enrolled. Patients were randomly assigned based on the day of admission to two groups according to treatment: group SS (n = 43) received intravenous systemic methylprednisolone alone, and group CT (n = 35) received intratympanic dexamethasone + systemic methylprednisolone. The primary outcome was to compare the hearing outcomes between the treatment groups based on different, widely accepted categories (Siegel, Kanzaki, modified Siegel and PTA4 gain). In consideration of the secondary outcome, we examined the effect of the various risk factors on the hearing improvement.No differences were detected regarding hearing improvement between the two groups, based on any criteria [Siegel's criteria (p = 0.604); Kanzaki's criteria (p = 0.720); modified Siegel's criteria (p = 0.524) and PTA 4 gain (p = 0.569)]. However, several clinical factors such as vertigo (p = 0.039), or cardiovascular comorbidity (p = 0.02) and the severity of initial hearing loss (p = 0.033) were found to bear a significant impact upon the hearing outcome.To the best of our knowledge, this is the first randomized controlled trial comparing high dose systemic and combination corticosteroid therapy in ISSNHL patients. Our findings suggest coexisting cardiovascular comorbidity, vertigo and severity of the initial hearing loss may bear a significantly higher impact upon hearing improvement, than the additional intratympanic steroid administration.The presented trial was registered in the European Union Drug Regulating Authorities Clinical Trials Database (name: Combinated systemic and intratympanic steroid therapy in idiopathic sudden sensorineural hearing loss, No.: 2017–000658-20) and with the ethical approval of The National Institute of Pharmacy and Nutrition (OGYÉI) (protocol No.: 7621, on 2017.02.16.)

NON-NECROTIZING DIFFUSE ANTERIOR SCLERITIS AS AN ISOLATED OCULAR MANIFESTATION OF SYSTEMIC LUPUS ERYTHEMATOSUS: A CASE REPORT

Introduction: Systemic lupus erythematosus (SLE) is an autoimmune disorder with heterogeneous clinical manifestation in numerous organ systems, including the eye. Ocular involvements have been reported in up to one-third of patients with SLE, although scleritis is considered a less common manifestation of the disease found in only about 1% of cases Case Report: A 46-year-old female patient presented with a painful right eye for 1 week. She reported having the same symptom last year which resolved without treatment. There was no known history of systemic immune-mediated diseases and no prior ocular trauma. Ophthalmological examination revealed dilatation of deep scleral vessels on the right eye. The patient tested positive for the antinuclear antibody and anti-double-stranded deoxyribonucleic acid tests. She was diagnosed with non-necrotizing diffuse anterior scleritis caused by SLE and was treated with topical prednisolone acetate and systemic methylprednisolone. After 1 week of treatment, the patient showed an improvement in ocular signs and symptoms. Discussion: Scleritis is a rare inflammatory disease usually associated with systemic immune-mediated diseases such as SLE. It can cause significant visual loss and may be life-threatening. We reported a non-necrotizing diffuse anterior subtype of scleritis presented as an isolated manifestation in SLE, which benefited from early diagnosis and treatment of corticosteroids. Conclusion: Scleritis may present as an early or isolated manifestation of systemic immune-mediated disease. Therefore, a comprehensive examination is of the essence to exclude multisystem disease and treat the underlying cause even when there is no systemic manifestation.

Ocular side effects of Trametinib and Dabrafenib: a case report

A 53-year-old man who has stage 4 non-small cell lung carcinoma and treated with Dabrafenib-Trametinib combination chemotherapy; presented with decreased bilateral visual acuity. We checked out slit lamp examination, fundoscopy, optical coherence tomography and fundus fluorescein angiography. In slit lamp biomicroscopy; bilateral posterior synechiae, granulomatous keratic precipitates and + 4 cells in the anterior chamber were detected. Cystoid macular edema and subretinal fluid accumulation were revealed in optical coherence tomography. Dabrafenib and Trametinib treatments were discontinued and systemic methylprednisolone, topical corticosteroid and topical cyclopentolate were started. His best corrected visual acuity was increased from counting fingers from 2 m to 0,9 bilaterally and cystoid macular edema and serous retinal detachment were completely regressed as a result of systemic and topical corticosteroid treatment.

Pediatric uveitis complicating in cataract formation regained normal visual acuity – a challenging case

Background: Pediatric uveitis and its complications are important causes of child blindness. Strong inflammatory response and unstable treatment compliance result in worse treatment outcome than adults and frequent recurrence. However, effective anti-inflammatory treatment can still lead to good result. Case report: We report a case of pan-uveitis in a 13-year-old patient, complicating in cataract formation who was successfully treated and regained 20/20 final visual acuity. The patient was admitted to us due to blurry vision, pain and redness on her left eye, with best-corrected visual acuity 12/20, intraocular pressure 15 mmHg, ciliary flush, anterior chamber cell and constricted pupil with poor light reflex. Her left eye was diagnosed with anterior uveitis and treated with topical prednisone acetate along with peri-orbital injection of dexamethasone. At 1-week follow-up, her left eye showed significant progress with best-corrected visual acuity being 16/20 and no inflammatory reaction detected. Due to social distancing in Covid-19 pandemic, she was unable to have follow-up examinations; her condition worsened to pan-uveitis which complicated in cataract formation and her visual acuity fell down to counting finger 0.5m. She was then treated with systemic methylprednisolone in 2 weeks and local corticosteroids in 6 months, including 3 consecutive peri-orbital injections of triamcinolone acetate with monthly interval and topical prednisone acetate; after that she underwent cataract surgery with anterior vitreous humor removed and intraocular lens implanted in the ciliary sulcus. At 1-month follow-up, best-correct visual acuity of her left eye was 20/20 and intraocular pressure was 16 mmHg, the inflammatory response of her left eye was completely in control. Conclusion: Effective anti-inflammatory treatment even after surgery (if existed) takes the decisive role in regaining patient’s vision. Cataract removal surgery on pediatric uveitis patients should combine with vitrectomy and the surgeon should be prepared to place the intraocular lens in the ciliary sulcus.

MANAGEMENT OF ULCERATIVE ORAL LICHEN PLANUS PREDISPOSED BY PSYCHOLOGICAL STRESS

Background: Oral lichen planus (OLP) is a chronic inflammatory autoimmune oral mucosa disease. The ulcerative type of OLP presents as erythematous ulceration with mucosal erosions surrounding whitish striae. The aetiology of OLP is unknown, but can be predisposed by psychological factors. Purpose: Reporting ulcerative oral lichen planus predisposed by psychological stress. Case: A 36 years old woman complained very painful ulcer in the right buccal mucosa and a grey-purple lower lip lesion for a year. It had been treated with topical corticosteroids, antibiotics, tretinoin, and vitamins but did not heal. Extraoral examination on the lower vermillion showed bluish-purple macules, diffuse and irregular borders, rough and painful. Intraoral examination in the right buccal mucosa showed an irregular yellowish-white ulcer with an erythematous area and white striae. Case Management: Screening for psychological stress by DASS 42 showed moderate stress and severe anxiety. Autofluorescence examination showed no malignant transformation sign. A complete blood count test showed low neutrophil and lymphocyte count. ANA test was normal. Systemic Methyl Prednisolone 8 mg was prescribed 2 tabs twice a day and tapered off after the lesion resolved within 1 week. Supportive treatments include Benzydamine HCl and multivitamins. Discussion: Stress, anxiety, and depression were possible factors of OLP mediated by the Hypothalamic-pituitary-adrenal (HPA) axis system and the Sympathetic-adrenal-medullary (SAM) system. Specific mechanisms are mediated by Antigen-specific CD8+ (CTLs) that are activated with the help of CD4+ T-cells. Non-specific mechanism mediated by MMP-9 activation. They led to the apoptosis of keratinocytes. Systemic corticosteroids are an important treatment for oral lichen planus that do not responded to topical steroids. Conclusion: Oral Lichen Planus is a chronic inflammatory disease that affects the oral mucosa and can be predisposed by psychological stress. Corticosteroid is very effective to treat oral lichen planus, especially the erosive-ulcerative type. Keywords: Oral Lichen Planus, Psychological Stress, Ulcerative

Inflammatory Indicators in Peripheral Blood in Sudden Sensorineural Hearing Loss Patients With Different Audiogram Shapes.

Objective: A retrospective study was conducted to explore the immune-inflammatory responses in sudden sensorineural hearing Loss (SSNHL) patients with different audiogram shapes. Methods: One hundred and ten inpatients with SSNHL were assigned to 4 subgroups according to the audiogram shape and treated with systemic methylprednisolone. The numbers of white blood cells, neutrophils, lymphocytes, platelets, and monocytes were counted. The neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), and the monocyte-to-lymphocyte ratio (MLR) were calculated and statistically analyzed. Results: Neutrophil-to-lymphocyte ratio, MLR, and systemic immune index (SII) of SSNHL patients were significantly higher than the control group, while PLR was not statistically significant. There were no statistical differences in NLR, PLR, MLR, and SII among the 4 subgroups. Conclusion: Immune-inflammatory response may be a common pathogenesis in all SSNHL patients with different audiogram shapes. The predictive value of these hematologic markers needs further research in the future.

Single High-Dose Systemic Methylprednisolone Administered Preoperatively Improves Pain Control and Sleep Quality After Total Hip Arthroplasty: A Double-Blind, Randomized Controlled Trial

BackgroundThis study was performed to evaluate the efficacy of preoperative high-dose methylprednisolone on pain levels and sleep quality following primary total hip arthroplasty. Material and methodsA double-blind, randomized controlled trial was performed in adults underdoing total hip arthroplasty. A computer-generated, permuted-block randomization scheme with a 1:1 ratio between the intervention (125 mg methylprednisolone) and control groups (normal saline) was utilized. Patients underwent a similar preoperative and postoperative protocol. Pain was assessed using the visual analog scale (VAS). Sleep quality was assessed at the 2-week postoperative visit using the Pittsburgh Sleep Quality Index (PSQI). ResultsWith a total of 70 patients, 35 patients were included in the intervention and placebo groups. Hospital stay was significantly shorter in the intervention group (1.5 ± 0.7 vs 2.0 ± 0.5 days, P = .03). Preoperative pain levels were similar between groups, while satisfactory pain control was achieved in a significantly larger number of patients in the intervention group (18 vs 8 patients, P = .009). The intervention group was significantly more likely to have a good sleep quality than the placebo groups (74% vs 31%, P = .001). No significant differences were found between preoperative and postoperative blood sugar levels. We did not observe any cases of early postoperative wound complication, infection, or deep vein thrombosis among our patients. ConclusionIn this randomized controlled trial, preoperative administration of 125 mg of methylprednisolone was found to improve pain control, as measured by VAS, 24 hours after surgery, and sleep quality, as measured by PSQI, 2 weeks following surgery.

Comparison of High-Dose, Short-Term Steroid and Low-Dose Long Term Steroid Use in ARDS Caused by COVID-19

Two hundred and two patients were recorded to be diagnosed with ARDS due to COVID 19 in the intensive care unit between June 1, 2020 and February 1, 2021. Patients were received systemic methylprednisolone for the short or long term and high or low doses were applied. Age, gender, APACHE II scores, steroid treatment protocol, time for intubation, length of stay (LOS), Neutrophil/Lymphocyte Ratio, C Reactive Protein (CRP), Procalcitonin, Lactate levels and Cytokine filter requirement, the prognosis and total costs were obtained from their records.

Comparison of high-dose, short-term steroid and low-dose long-term steroid use in ARDS caused by COVID-19: Retrospective cohort study

Background/Aim: Given the increasing incidence and mortality caused by coronavirus 2019 ( COVID-19) worldwide, beneficial and effective treatment for patients in the early pulmonary phase is still of great importance. Fifteen-day continuous hemodynamic, laboratory, and clinical courses of patients with acute respiratory distress syndrome (ARDS) due to COVID-19 who received short-term high-dose and long-term low-dose systemic methylprednisolone were compared. Methods: Two hundred and two patients were reported to have ARDS due to COVID-19 in the intensive care unit between June 1, 2020 and February 1, 2021. The patients were divided into two groups: (1) short-term high-dose and (2) long-term low-dose systemic methylprednisolone. Age, gender, Acute Physiology and Chronic Health Evaluation (APACHE II) scores, steroid treatment protocol, intubation duration, length of stay (LOS), Neutrophil/Lymphocyte Ratio, C-reactive protein (CRP), procalcitonin, lactate levels, cytokine filter requirements, the prognosis, and total costs were obtained from their records. Results: It was determined that elderly patients tended to be given low doses of steroids. No significant differences between the two treatment protocols in terms of other parameters were found. It was determined that high doses of steroids affected only CRP levels (P

Association of Serum Ferritin Levels and Methylprednisolone Treatment With Outcomes in Nonintubated Patients With Severe COVID-19 Pneumonia

Serum ferritin, an acute phase marker of inflammation, has several physiologic functions, including limiting intracellular oxidative stress. Whether the effectiveness of corticosteroids differs according to serum ferritin level in COVID-19 has not been reported. To examine the association between admission serum ferritin level and methylprednisolone treatment outcomes in nonintubated patients with severe COVID-19. This retrospective cohort study included patients with severe COVID-19 admitted to an academic referral center in Stony Brook, New York, from March 1 to April 15, 2020, receiving high-flow oxygen therapy (fraction of inspired oxygen, ≥50%). The outcomes of treatment with methylprednisolone were estimated using inverse probability of treatment weights, based on a propensity score comprised of clinical and laboratory variables. Patients were followed up for 28 days. Data were analyzed from December 19, 2020, to July 22, 2021. Systemic methylprednisolone administered per the discretion of the treating physician. The primary outcome was mortality, and the secondary outcome was a composite of death or mechanical ventilation at 28 days. Among 380 patients with available ferritin data (median [IQR] age, 60 years [49-72] years; 130 [34.2%] women; 250 [65.8%] men; 310 White patients [81.6%]; 47 Black patients [12.4%]; 23 Asian patients [6.1%]), 142 patients (37.4%) received methylprednisolone (median [IQR] daily dose, 160 [120-240] mg). Ferritin levels were similar in patients who received methylprednisolone vs those who did not (median [IQR], 992 [509-1610] ng/mL vs 893 [474-1467] ng/mL; P = .32). In weighted analyses using tertiles of ferritin values (lower: 29-619 ng/mL; middle: 623-1316 ng/mL; upper: 1322-13 418 ng/mL), methylprednisolone was associated with lower mortality in patients with ferritin in the upper tertile (HR, 0.16; 95% CI, 0.06-0.45) and higher mortality in those with ferritin in the middle (HR, 2.46; 95% CI, 1.15-5.28) and lower (HR, 2.43; 95% CI, 1.13-5.22) tertiles (P for interaction < .001). Composite end point rates were lower with methylprednisolone in patients with ferritin in the upper tertile (HR, 0.45; 95% CI, 0.25-0.80) but not in those with ferritin in the middle (HR, 0.83; 95% CI, 0.50-1.39) and lower (HR, 0.89; 95% CI, 0.51-1.55) tertiles (P for interaction = .11). In this cohort study of nonintubated patients with severe COVID-19, methylprednisolone was associated with improved clinical outcomes only among patients with admission ferritin in the upper tertile of values.

Systemic methylprednisolone for hearing preservation during cochlear implant surgery: A double blinded placebo-controlled trial

AimTo assess whether a single, peri-operative, high dose of methylprednisolone can improve the preservation of residual acoustic hearing following cochlear implantation (CI). MethodsThis was a double blinded placebo-controlled trial, performed in a tertiary academic centre. The hypothesis was that methylprednisolone would improve the preservation of hearing, and lower electrode impedances. Adult patients (18–85 years) with hearing at 85 dB or better at 500 Hz in the ear to be implanted were randomly allocated to either treatment (methylprednisolone, 1g administered intravenously upon induction of anaesthesia) or control (normal saline infusion). As per standard clinical practice, all patients received a routine dose of dexamethasone (8 mg intravenously) on induction of anaesthesia. Implantation was undertaken with a slim and flexible lateral wall electrode via the round window. Surgical technique was routine, with adherence to soft surgical principles. The primary outcome was hearing preservation within 20 dB at 500 Hz, 12 months following cochlear implantation. Secondary outcomes included hearing preservation at 6 weeks and 3 months, monopolar electrode impedance, and Consonant-Vowel-Consonant (CVC) Phoneme scores at 3 and 12 months after surgery. ResultsForty-five patients were enrolled into the control group and 48 patients received the steroid. The number of patients achieving hearing preservation at 12 months did not differ significantly between those receiving methylprednisolone treatment and the controls. There were no differences in hearing preservation at any frequency at either 6 weeks or 3 months after implantation. Neither CVC phoneme scores nor electrode impedances differed between the groups. ConclusionsThis paper demonstrates that high-dose local steroid injection at surgery was not effective in preventing a loss of residual hearing, improving speech perception, or lowering electrode impedances. The findings were contrary to the experimental literature, and emerging clinical evidence that steroid elution from implant electrodes influences cochlear biology in humans. We found no evidence to support the widely-held practice of administering intravenous steroids in the perioperative period, in an attempt to preserve residual hearing.

The Outcome of Prompt Concomitant Single-Dose High-Concentration Intratympanic and Tapered Low-Dose Oral Systemic Corticosteroid Treatment for Sudden Deafness.

To investigate the efficacy of prompt concomitant corticosteroid treatment with single application of high-concentration intratympanic (IT) dexamethasone and tapered low-dose systemic methylprednisolone of an idiopathic sudden sensorineural hearing loss (ISSNHL). Between September 2017 and September 2019, 86 adult patients met the criteria for the diagnosis of ISSNHL at baseline evaluation. The patients received immediate concomitant treatment with single high-concentration (24 mg/mL) IT dexamethasone and low-dose (48 mg) oral methylprednisolone for 1 week followed by tapered doses. Improvement in pure-tone average (PTA) and word recognition score (WRS) was determined after 1 and 6 months. A total of 63 patients met the requirements for the analysis. PTA improved in 71% and WRS improved in 59% of patients with ISSNHL. PTA and WRS were statistically significantly different at different time points during the intervention (p<0.0005). Hearing improved in all measured frequencies from 125 to 8000 Hz until the second follow-up. In 65.4% of patients with tinnitus, the WRS has improved compared with 27.3% without tinnitus (p<0.05). In 69.2% of patients without vertigo, the WRS has improved compared with 41.7% with vertigo (p<0.05). Prompt concomitant single high-concentration IT and low-dose systemic corticosteroid treatment is efficient in recovering hearing loss and speech discrimination in ISSNHL. Tinnitus positively predicts hearing outcome. Vertigo negatively predicts speech discrimination recovery.

P0380INFECTION PROFILE AND ASSOCIATED RISK FACTORS IN AGGRESSIVE GLOMERULONEPHRITIS TREATED WITH INDUCTION AND MAINTENANCE REGIMENS OF IMMUNOSUPPRESSIVE THERAPY

Abstract Background and Aims Infections remain an important contributor to the morbidity and mortality of immunosuppressive (IS) therapy in aggressive glomerulonephritis. We sought to investigate the infection profile and associated risk factors in a compiled cohort of patients with lupus nephritis (LN), cryoglobulinemic vasculitis (CryoVas) and ANCA-associated vasculitis (AAV) treated with induction and maintenance IS regimens. Method A total of 162 patients (101 with LN, 24 with CryoVas and 37 with AAV) were retrospectively reviewed for any infection that occurred from initiation of induction therapy. Infections were graded (1-5) according to the Common Terminology Criteria for Adverse Events. Infection site and type of microorganism were also recorded. Univariate and multivariate Cox proportional hazard regression analysis were performed in order to identify independent risk factors for infection. Results Eighty-two patients (50.6%) had at least one infection with a total 179 episodes of infection occurring during a median follow-up of 12 months (IQR:4-36.25 months). The majority of patients (64 of 82) had infections during the first 24 months since IS treatment initiation with a 24-month infection-free rate of 55%. The most common site was lung infection (in 32.7% of patients), while 39.5% of patients had bacterial infections (1.8% with Mycobacterium tuberculosis). 36.7% of patients had severe infections (grade 3 or higher) with 4.4% of infection-related deaths (8 patients). The most common induction regimen was cyclophosphamide in addition to corticosteroids (62%), while 43% received either mycophenolate mofetil or azathioprine in addition to corticosteroids as a maintenance regimen. In univariate Cox regression analysis, chronic obstructive pulmonary disease (HR 3.91; 95% CI, 1.76-8.68, p=0.001), pulmonary involvement in the setting of systemic disease (HR 2.35; 95% CI, 1.26-4.37, p=0.007), pulse methylprednisolone (HR 2.7; 95% CI, 1.7-4.31, p=0.001) and high-dose (≥30 mg/day) oral corticosteroids (HR 3.38; 95% CI, 2.11-5.43, p=0.001) were risk factors for infection. In multivariate Cox regression analysis, high-dose oral corticosteroids (HR 2.67; 95% CI, 1.5-4.76, p=0.001) remained an independent predictor of infection risk. Of the risk factors associated with severe infections (grade 3 or higher), in univariate analysis we identified pulmonary involvement in the setting of systemic disease (HR 3.65; 95% CI, 1.72-7.77, p=0.001), pulse methylprednisolone (HR 3.56; 95% CI, 1.7-7.3, p=0.001), high-dose (≥30 mg/day) oral corticosteroids (HR 3.56; 95% CI, 1.77-7.16, p=0.001), estimated GFR (HR 0.98; 95% CI, 0.98-0.99, p=0.01) and AAV (by comparison to CryoVas and LN) (HR 2.81; 95% CI, 1.39-5.66, p=0.004) as risk factors for infection. After multivariate adjustment, pulmonary involvement in the setting of systemic disease (HR 2.38; 95% CI, 1.01-5.73, p=0.05) and high-dose oral corticosteroids (HR 2.44; 95% CI, 1.04-5.72, p=0.04) were identified as independent predictors of infection risk. Conclusion Infections occur frequently with current immunosuppressive regimens in aggressive glomerulonephritis. In addition to pulmonary involvement in the setting of systemic disease, a high dose corticosteroid regimen was the most significant risk factor for infection.

Trial for a trial: Is there hope? – Optic neuritis treatment trial protocol in patients with traumatic optic neuropathy

Aims: The aim of this study was to analyze the clinical profile, visual outcome, factors predicting the visual outcome, and response to systemic methylprednisolone as per the Optic Neuritis Treatment Trial (ONTT) protocol in patients with traumatic optic neuropathy (TON). Study Design: This was a prospective observational study. Subjects and Methods: All cases who had decreased visual acuity (VA) following impact head/orbital injury were evaluated with detailed history, and ophthalmic evaluation was done. Those who were diagnosed to have indirect TON were treated with intravenous methylprednisolone 500 mg twice daily for 3 days, followed by oral prednisolone 1 mg/kg for 11 days. Visual outcome was assessed at 1 week, 1 month, 3 months, and 6 months. The results were statistically analyzed. Results: 34.65% had severe loss of vision (

进食藜导致植物日光性皮炎11例临床分析

Objective To investigate clinical characteristics and treatment of phytophotodermatitis due to ingesting Chenopodium album. Methods This study included 11 patients with phytophotodermatitis caused by ingesting Chenopodium album collected from Department of Dermatology, Affiliated Hospital of Jining Medical University from 2013 to 2017. The patients′ general information, clinical manifestations, laboratory test results, treatment and prognosis were retrospectively analyzed. Results All the 11 patients were female, and their age ranged from 45 to 62 years. They all had a history of ingesting Chenopodium album and exposing to sunlight within 1 - 2 days prior to the disease onset. Clinical manifestations included symmetrically distributed, painful and pruritic, nonpitting, swelling erythema on the face and back of both hands and at sunexposed sites of forearms, with a tense and bright surface. Increased white blood cell counts were observed in 6 patients, and increased eosinophil counts in 1. All of the 11 patients were treated with systemic methylprednisolone, loratadine, ebastine, spironolactone, furosemide and omeprazole as well as topical agents, 2 also received human immunoglobulin treatment, and 3 were also treated with oral ibuprofen and codeine for painful lesions. Ten patients received obvious improvement and were discharged after 7 - 10 days of treatment, and no pigmentation or scars were observed after 1-year follow-up. Skin necrosis occurred on the back of both hands in 1 patient after 7-day treatment, and scars remained in the patient after follow-up of half a year. Conclusions Chenopodium album-induced phytophotodermatitis commonly manifests as swelling erythema on the exposed body sites. After confirmed diagnosis, Chenopodium album ingestation and sunlight exposure should be avoided, and timely antianaphylactic treatment should be considered to effectively control the disease. Key words: Dermatitis, phototoxic; Chenopodium album; Phytophotodermatitis

Graft-versus-host disease and liver transplantation – It can be survived

Background: Graft-versus-host disease (GVHD) following orthotopic liver transplantation (OLT) is a rare but deadly complication. Several risk factors have been mentioned by different authors over the past years. Methods: A 63 year old male presented with fever and fatigue 3 months after OLT. After merely fast progression of the symptoms and worsening of condition despite antibiotic application of Meronem, the patient was transferred to our intensive care unit. The patient developed mucosal lesions as well as a generalized exanthema. After Stevens-Johnson-Syndrome could be ruled out, skin lesions were treated with local steroids and in addition systemic methyl-prednisolone in combination with cyclosporine was administered. Under this regime the patient improved steadily. Results: The patient could be stabilized and eventually be dismissed from our hospital. Biopsy of skin and colon confirmed the diagnosis of GVHD. Conclusion: Our case represents one of the few patients described in current literature to actually survive this complication. The prevention of GVHD seems highly important since most treatment regimes are reported as not successful. We have experienced a case of acute GVHD following adult-to-adult OLT with a positive outcome. According to the literature high-dose steroids in combination with calcineurin inhibitors are ineffective in the treatment of GVHD after OLT. Nevertheless, in our case steroids continously tapered down in addition with cyclosporin seemed to be effective in treating this complication.

Successful treatment of a female pediatric patient with carbamazepine-induced toxic epidermal necrolysis: Active wound care and systemic therapy.

We describe a 6‐year‐old female patient who developed carbamazepine‐associated toxic epidermal necrolysis. With active wound care, systemic methylprednisolone and intravenous immunoglobulin pulse therapies and multidisciplinary supportive care, the patient improved significantly. This case indicates that improving the management of Stevens‐Johnson syndrome/Toxic epidermal necrolysis patients requires attention not only to the process of wound management but also to individual supportive care and active therapeutic intervention. Only through this can standardized care, including muco‐cutaneous and visceral wound care, be delivered to provide high‐quality care with improved clinical prognosis and quality of life.

Comparison of efficiency of inhaled and intravenous corticosteroid on pregnant women with COPD and the effects on the expression of PCT and hs-CRP.

The efficiency of inhaled and systemic corticosteroids on pregnant women with chronic obstructive pulmonary disease (COPD) was investigated. The study also compared the effects of the administration on the expression of inflammatory mediator procalcitonin (PCT) and high-sensitivity C-reactive protein (hs-CRP). A total of 120 pregnant COPD patients were recruited and randomly allocated into the following three groups: Intravenous corticosteroid treatment group (n=42), inhaled corticosteroid treatment group (n=38), and control group (without any corticosteroid treatment, n=40). Patients of the all three groups received symptomatic supportive treatments including oxygen therapy, anti-infection therapy, expectorant, and bronchodilator. The serum PCT and hs-CRP expression levels were measured before treatment and after 7 days of treatment. Moreover, the clinical parameters such as symptoms, blood gas analysis parameters, pulmonary function indexes, fasting blood glucose (FBG) and adverse reactions were recorded. The overall clinical effective rates of the group received budesonide inhalation and the group receiving systemic methylprednisolone treatment were comparable. Both treatments were able to reduce the levels of inflammatory mediators, hs-CRP and PCT. On the other hand, treatments increased PaO2 of arterial blood gas while reducing PaCO2, thereby improving the lung function (FEV1% pred and FEV1/FVC) (P>0.05). The study observed that the FBG levels in COPD patients receiving systemic corticosteroid treatment were significantly increased, while budesonide inhalation did not significantly affect the FBG levels. In addition, rates of adverse events (such as mouth dry, oral ulcers, hoarseness) of systemic corticosteroid treatment group were significantly higher than those in inhaled corticosteroid treatment group and control group (38.1% vs. 17.5% vs. 5.0%, comparison between groups: P<0.05). In conclusion, inhaled and systemic use of corticosteroid both significantly improved dyspnea and other clinical symptoms of pregnant COPD patients by increasing oxygen partial pressure, correcting hypoxemia, and enhancing lung function. Moreover, fewer adverse reactions were observed with inhaled corticosteroid treatment, suggesting that inhaled administration is a relatively good, safe and effective treatment for pregnant COPD patients.

The effect of nebulised magnesium sulphate in the management of childhood moderate asthma exacerbations as adjuvant treatment

BackgroundAfter the bronchodilator effect of magnesium was shown, the use of magnesium in treatment of asthma exacerbations became common. With the results of recent studies, the use of intravenous magnesium in severe asthma exacerbations took its place. We aimed to examine the effects of adding isotonic magnesium sulphate instead of isotonic saline into nebulised salbutamol on the Modified Pulmonary Index Score (MPIS) and the hospitalisation rate in moderate asthma exacerbations. MethodsOur study population included 100 children age between 3 and 15 years with asthma admitted to emergency department due to moderate asthma exacerbations. The patients were randomised to placebo or magnesium, with 50 patients in each arm. All patients received 1mg/kg of systemic methylprednisolone at the beginning of treatment and thereafter received either nebulised salbutamol (0.15mg/kg/dose) and 1ml magnesium sulphate (15%)+1.5ml isotonic saline on three occasions at roughly 20min intervals (Magnesium group) or nebulised salbutamol (0.15mg/kg/dose) and 2.5ml isotonic saline mixture on three occasions at roughly 20min intervals (Placebo group). The MPIS of patients on 0th min, 20th min, 40th and 120th min were calculated and compared. The primary outcome was to compare MPIS values at the end of 120th min. ResultsBoth groups have similar demographic, allergic characteristics and baseline MPIS scores. When the MPIS scores in the 120th min and admission rates in the 200th min, there was no significant difference between the two groups. ConclusionsThe use of nebulised magnesium sulphate in moderate asthma exacerbation as adjuvant treatment showed no benefit to standard treatment in our study.